Health system neglects northern patients by design: Doctor
Veteran physician says his northern patients don't receive care other Canadians take for granted
Canadians like to think they have one of the best health care systems in the world — and that it's there for everybody, no matter what. But Dr. Mike Kirlew, a family physician based in Sioux Lookout, Ont., and one of the few doctors who works in the remote Indigenous communities in the northernmost part of the province, says that's not true.
"My patients do not receive anywhere close to a comparable level of care that other Canadians would enjoy. They just don't," Dr. Kirlew says. "That's the height of un-Canadianness."
Originally from Ottawa, Dr. Kirlew moved to Sioux Lookout, Ont., after medical school. He only expected to stay a few months — 10 years later he's fallen in love with the North.
He says health care in Canada is supposed to be based on equality and fairness, but these days he wonders if that's just something Canadians like to tell themselves.
"The system isn't broken, the system is doing what it was originally designed to do," says Dr. Kirlew. "It was never meant to provide care. It was meant to deny care."
CBC's The National sent Nick Purdon and Leonardo Palleja to follow Dr. Kirlew on the job and find out how people in Ontario's far North are being served by the health care system.
If you want to understand health care in northern Ontario, it's best to start in Sioux Lookout.
The town of about 5,000 is a medical hub for many of the 49 Indigenous communities spread out across a swath of northern Ontario roughly the size of France.
Known collectively as the Nishnawbe Aski Nation (NAN), most of the communities are so remote they don't have road access.
For the 45,000 people who live in the territory, the only way to get comprehensive medical care is to fly to a centre like Sioux Lookout.
After years of waiting, 36-year-old Bernice Boyce did just that this past September.
She left her home in Wapekeka, Ont., and moved 500 kilometres south to Sioux Lookout so her 14-year-old son Joshua could get the help he needs.
"We don't have anything back home," Bernice Boyce says. "And that's why we are here."
The doctor high-fives Joshua and asks Bernice if he is still using his puffer.
Dr. Kirlew says Joshua was unable to get regular access to occupational therapy in Wapekeka, and he struggled at school and at home.
"Can you imagine having to leave your home to be able to access basic services?," says Dr. Kirlew. "Can you imagine making that decision?"
A hostel unlike any other
It's not just Bernice and Joshua Boyce who had to leave their communities to get health care. For many northern Canadians a multi-day trip is a fact of life for even a simple medical procedure or therapy session.
The Jeremiah McKay Kabayshewekamik hostel is a 100-bed facility attached to the medical centre in Sioux Lookout where patients from far northern Ontario communities stay while they are in town.
Last year a total of 36,394 clients and escorts stayed at the hostel, which has an operating budget of more than $6 million a year. Another 15,443 people were booked into local hotels when the hostel was full.
In late January when The National visited Sioux Lookout, there were 95 patients staying at the hostel. Another 153 were being housed in hotels in town.
Here are a few of the patients we met that day:
Jordan Strang, 25, from Poplar Hill First Nation, holds his 2-year-old daughter Jordja. He's at the hostel awaiting the birth of his fourth child — a baby boy.
Christian Sakakeesic, 19, from Cat Lake, waits to see a counselor.
"I try hard to cope," Sakakeesic says. "I tried hard to talk about my feelings back in my reserve, but nobody is there to listen."
Ivy also flew in from Cat Lake, with her mom Verna Wesley.
"It's hard to travel out here just to see a doctor," Verna says. "I am missing a lot of work at home right now, which is going to be hard on my payday."
Grady Kakekagamick, 37, is from Deer Lake. He's at the hostel for the birth of his daughter.
Life at the hostel
Not all of the hostel's guests are there for a short-term stay. Stephan Fiddler has lived alone in room No. 233 for 18 months.
He left his home in Bearskin Lake because of diabetes and kidney failure. Fiddler needs dialysis three times a week and there isn't a dialysis machine in his community.
"I am going blind, so I need some help while I am here," Fiddler says.
"I left my family in Bearskin, which is very hard to do. It's very lonely here. I miss family. And the things I used to do."
Fiddler is in an impossible situation. If he ever decides to return home to his family in Bearskin Lake and stops getting dialysis, he'll die.
"This is Canada. I think all Canadians should get the same services as people who live down south," he says.
"Wouldn't it make more sense," says Dr. Kirlew, "to put the infrastructure — the dialysis machine — in the community? Wouldn't that be cheaper, too?"
And Dr. Kirlew points out that the people who fly to Sioux Lookout for their medical needs are actually the lucky ones, because not everyone makes it to town. He requests coverage for his patients to travel and the federal government decides who is eligible and who isn't.
"By controlling transportation," the doctor says, "you are controlling care.
"There are times when a patient might pass away, or you witness several patients passing away because of lack of access to certain services, and it makes you want to give up," he says.
On the ground in Wapekeka
Once a month, Dr. Kirlew flies north from Sioux Lookout to Wapekeka, Ont., where he has been the community's doctor for the past 10 years.
"I love going up there," Dr. Kirlew says.
"It has experienced significant tragedy in the past because of a number of suicides," he adds. "But I also see hope and a desire for change and a desire to transform the system."
There are three full-time nurses who serve the 400 or so people in Wapekeka.
But they have limited facilities to provide care. There's no X-ray machine or ultrasound.
There's no ambulance, either. The only medical transportation in the community is a regular SUV, and the driver has only basic first aid training.
Since there's only a doctor in town for about a week every month, there's a long list of people who want to see Dr. Kirlew when he arrives.
Three-year-old Chase is his first patient of the day.
Chase has a bad rash on his face, but what his dad Jason Baxter, 42, is more worried about is the boy's recent allergy attack.
"He almost died in Thunder Bay. Lucky thing he was actually in town when it happened and not up here," says Baxter.
In Wapekeka, a simple peanut allergy is a big deal.
Dr. Kirlew says they've run out of basic medication such as Ventolin to treat an anaphylactic reaction before. And if there are complications, there's no guarantee medical help will arrive in time.
"We don't let him go anywhere or visit anybody else's home, because of all the time it takes for medical help to get here," Baxter says. "He stays at home. We don't want to take that chance."
Tracy Winter, 36, sees the doctor about her daughter Jayla, who is seven. Jayla's having trouble forming some of her words and she's falling behind at school.
Winter says she's been waiting for years to get speech therapy for her daughter in Wapekeka.
"That's a real problem in our region — getting kids access to those services," Dr. Kirlew says. "And even when we do, sometimes we can only get them once — it's very difficult to get things on an ongoing basis."
Dr. Kirlew has already written two letters to the federal government trying to get Jayla access to speech therapy.
He promises the family he'll write another.
"We have a system that's fairly efficient at denying children care," he says. "How can we have that in a country like this?"
Hope for change
One of the realities of life for a northern doctor is that you work, sleep and cook at the nursing station.
On this morning, Dr. Kirlew has breakfast with Sol Mamakwa, a health adviser with the Nishnawbe Aski Nation. Mamakwa, 47, is in Wapekeka to learn more about the situation on the ground so he can improve the health care for his people.
Over breakfast they talk about some of the simple things they think should be done.
"We see so many parents bring in their children, looking to access developmental services," says Dr. Kirlew. "These services could fly into the community."
Mamakwa, who grew up in Kingfisher Lake, about 60 kilometres to the south of Wapekeka, says it wouldn't just be cheaper for health care professionals to fly into communities to see groups of kids, rather than the kids flying out. It would also be less disruptive.
"I hear a lot of the health care is broken," he says. "But when you actually think about it, it's not broken. It is in fact doing exactly what it has been designed to do: To diminish the rights of our people, the health of our people," he says.
"Sometimes I would even go as far as saying that the system is killing our people."
Mamakwa points to the three young girls from Wapekeka who committed suicide last year.
He says that six months before the tragedy, the community had asked the federal government for mental health support. The request was denied.
"When you hear of a young girl or boy, 11 or 12 years old, dying by suicide, it just pushes you to make more change. To bring change for our people," he says.
"We cannot give up. We cannot."
Health Canada has since pledged $380,000 for suicide prevention strategies in Wapekeka.
But Mamakwa says the real solution isn't for governments to give communities more money.
"We need to dismantle the system and rebuild it up, from the community up," he says.
This past summer the provincial and federal governments, along with NAN's grand chief Alvin Fiddler, took a step toward self-government when they signed an agreement in principle to give health care in the territory over to Indigenous control.
'You forget what normal is'
After a long day seeing patients at the nursing station, Dr. Kirlew makes a house call and the reality on the ground hits again.
Donnie Brown had a stroke four years ago from a ruptured aneurysm. Much of the right side of his body is numb.
"He can't feel," says Elsie, his wife of 40 years who takes care of her husband by herself. "Especially on his foot — he gets cold, too."
In the four years since his stroke, Donnie Brown has only had a single rehab appointment. These days he has a hard time communicating.
"We end up shouting because we can't understand each other sometimes," Elsie says. "It's hard. It's been four years the way he is."
On the living room couch Dr. Kirlew listens to Donnie's breathing — but there isn't much else he can do.
"I wish I could provide some home care, because that would be something people would get down south," he says. "But we don't have access to that kind of service."
Kirlew packs his stethoscope and on the drive back to the nursing station he reflects on a long day of seeing patients.
"You forget what normal is," he says. "You have to remind yourself of what normal is. That's part of the fight.
"They have this phrase in medicine called the Hippocratic Oath," he continues. "We take it when we graduate from medical school. It means 'to do no harm.' Sometimes I see my role as a physician is to minimize the harm that the system is already doing to them."
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